Abstract

Background

Patients undergoing alcohol withdrawal in the intensive care unit (ICU) often require
escalating doses of benzodiazepines and not uncommonly require intubation and mechanical
ventilation for airway protection. This may lead to complications and prolonged ICU
stays. Experimental studies and single case reports suggest the α2-agonist dexmedetomidine is effective in managing the autonomic symptoms seen with
alcohol withdrawal. We report a retrospective analysis of 20 ICU patients treated
with dexmedetomidine for benzodiazepine-refractory alcohol withdrawal.

Methods

Records from a 23-bed mixed medical-surgical ICU were abstracted from November 2008
to November 2010 for patients who received dexmedetomidine for alcohol withdrawal.
The main analysis compared alcohol withdrawal severity scores and medication doses
for 24 h before dexmedetomidine therapy with values during the first 24 h of dexmedetomidine
therapy.

Results

There was a 61.5% reduction in benzodiazepine dosing after initiation of dexmedetomidine
(n = 17; p < 0.001) and a 21.1% reduction in alcohol withdrawal severity score (n = 11; p = .015). Patients experienced less tachycardia and systolic hypertension following
dexmedetomidine initiation. One patient out of 20 required intubation. A serious adverse
effect occurred in one patient, in whom dexmedetomidine was discontinued for two 9-second
asystolic pauses noted on telemetry.

Conclusions

This observational study suggests that dexmedetomidine therapy for severe alcohol
withdrawal is associated with substantially reduced benzodiazepine dosing, a decrease
in alcohol withdrawal scoring and blunted hyperadrenergic cardiovascular response
to ethanol abstinence. In this series, there was a low rate of mechanical ventilation
associated with the above strategy. One of 20 patients suffered two 9-second asystolic
pauses, which did not recur after dexmedetomidine discontinuation. Prospective trials
are warranted to compare adjunct treatment with dexmedetomidine versus standard benzodiazepine
therapy.